HomeMy WebLinkAbout0950 .7~ ,
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STATE OF FLORIDA
COUN~Y OF ST. LUCIE
NON-FQREIGN AFFIDAVIT
SALE OF REAL PROPERTY INTEREST
Before me, the undersigned authority, duly authorized in the
State and County aforesaid, personally appeared WALTER W.
I~UPTON and SYLVIA LUPTON, his wife, who deposes and says:
That~ declarant is selling the real property located at
Paso Robles, in the City of Fort Pierce, County of St. Lucie,
State of Florida, described as:
Lot 4, Black 2, LAKEWOOD PARK UNIT 8B, according to
the plat thereof, as recorded in Plat Book 11,~Page
4~, of tne rublic Records or 5t. Luci~ i ~tir~tiy,
Florida.
That this declaration is made for the benefit of the
PurGhasers Douglas K. Tomlinson and Lori Tomlin~on, his wife,
for compliance w~th the Federal Tax Reform Act of 1984.
That the declarants United St e taxpa er identification
number are Q.S`S Z and
~,5~, _ -~Q~~2 , respectively.
That the declarants are not a nonresident alien for
purposes of United States Income Taxation nor is declarant a
foreign person subject to withholding provisions of trie above- `
referenced Act.
Declarants home address is S-' r~ " ~ •
The declarants understand that this Affi it may be
disclosed to the Internal Revenue Service by the purchas~r,
title insurance ~agent or closi.ng agent and that any false
statement made by the declarant could be punished by fine,
imprisonment, or both. The declarant will testify, declare, or
certify before any tribunal, officer, or person, in any case
now pending or which may hereinafter be instituted, to the
t truth of the facts hereinabove set forth.
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' Under penalties of perjury, the undersigned hereby
~ declares that the undersigned has (have) examined this Non-
For~ign Affidavit and to the best of the knowledge and belief
! of the Declarant, it is true, correct and complete.
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~ A R W. PTON
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~ SYLV U ON
SWA~t;:~-~. ~nd subscribec~ before me
~ this;~"~n~ of Sep ember,.1986.
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i .'NOtB=y Pu, _ Notary Publa, State ot Rorida "7aa~ (
My ~commi~sion e~tpires : My Commission Expires Aprd 12, t488
; baQ~d iM~ IroY F~ia-Insunnu, lec,
•86 - A9 :59 `
! `:T~is ~;~~i~YUmen was prepared by : ~ a :
+ JO~.,`~~AR~ SHERRARD, P.A. i~
Atto~3~~y at Law FiL=:' ; , `
Post Office Box 4332 ROGE~ :
Fort Pierce, Florida 33~448 ST. LUC~: -
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soo~5~.3 ~~cE 943 3